背景:Sugammadex对易感患者术后肺部并发症(PPC)的疗效,与新斯的明相比,仍然不确定。评估加泰罗尼亚手术患者的呼吸风险(ARISCAT)组研究人员提出了早期识别易感患者的风险指数,具有优秀的外部验证辨别能力。应用荟萃分析技术评估Sugammadex对具有ARISCAT定义的危险因素的患者的PPC的疗效。
方法:该研究在PROSPERO注册,编号CRD42021261156。我们搜索了PubMed,Scopus,Embase,科克伦图书馆,GreyNet,和OpenGrey用于符合条件的随机对照试验(RCT),而不限制语言或发表年份。
结果:纳入12个RCTs,包括1182名PPC易感患者。在接受sugammadex的易感患者中,观察到PPC的发生率大幅降低[RR0.66;95%CI(0.54,0.80),p<0.01],研究间异质性水平较低(I2=45.98%;H2=1.85)。在避免残余神经肌肉阻滞(NMB)方面也证明了类似的保护作用[RR0.25;95%CI(0.11,0.56);p<0.01],肺不张[RR0.74;95%CI(0.59,0.95);p=0.02],肺炎[RR0.49;95%CI(0.28,0.88);p=0.02],和呼吸衰竭[RR0.61;95%CI(0.39,0.96);p=0.03]。在不良事件方面没有观察到差异[RR0.85;95%CI(0.72,1.01);p=0.06]。
结论:低到中等质量的证据表明,在具有ARISCAT定义的危险因素的患者中,Sugammadex在NMB逆转方面优于新斯的明在降低PPC和残留NMB的可能性方面具有优势。临床医生在治疗对PPC敏感的患者时可能会重新评估逆转剂的类型。
The efficacy of sugammadex on postoperative pulmonary complications (PPCs) in susceptible patients, compared with neostigmine, remains indeterminate. The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) Group Investigators proposed a risk index for the early identification of susceptible patients, with excellent externally validated discrimination ability. Meta-analytical techniques were applied to evaluate the efficacy of sugammadex on PPCs in patients with ARISCAT-defined risk factors.
The study is registered on PROSPERO, number CRD42021261156. We searched PubMed, Scopus, Embase, Cochrane library, GreyNet, and OpenGrey for eligible randomized controlled trials (RCTs) without restricting the language or year of publication.
Twelve RCTs consisting of 1182 patients susceptible to PPCs were included. A robust reduction was observed on the incidence of PPCs in susceptible patients who received sugammadex [RR 0.66; 95% CI (0.54, 0.80), p < 0.01], with a low level of between-study heterogeneity (I2 = 45.98%; H2 = 1.85). Similar protective effects were also proved in avoiding residual neuromuscular block (NMB) [RR 0.25; 95% CI (0.11, 0.56); p < 0.01], atelectasis [RR 0.74; 95% CI (0.59, 0.95); p = 0.02], pneumonia [RR 0.49; 95% CI (0.28, 0.88); p = 0.02], and respiratory failure [RR 0.61; 95% CI (0.39, 0.96); p = 0.03]. No difference was observed regarding adverse events [RR 0.85; 95% CI (0.72, 1.01); p = 0.06].
Low to moderate quality of evidence demonstrated the edge of sugammadex over neostigmine for NMB reversal in reducing the likelihood of PPCs and residual NMB in patients with ARISCAT-defined risk factors. Clinicians may reassess the type of reversal agent when treating patients susceptible to PPCs.